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DeBakey type I TAAA
Originates in the ascending aorta, propagates at least tot he aortic arch and often beyond it distally
DeBakey Type III TAAA
Originates in the descending aorta and extends distally down the aorta or rarely retrograde into the aortic arch and ascending aorta
What are considerations pre-op for the TAAA pt.
prepare for blood loss
might need DLT, deep hypothermic arrest, partial or full heart bypass, descending spinal drain
poss. mediastinal mass
What are 5 considerations for the TAAA patient
large blood loss
a-line on right side
Why is there are high risk for paralyzation in the TAAA patient
Because there is lack of perfusion to the spinal nerves
What are 3 surgical approaches to the open TAAA
simple clamp and sew
partial left-sided heart bypass
Name 3 characteristics of the simple clamp and sew method
leads to ischemia distal to the cross clamp
used for short and emergency procedures
exaggerated response to clamping and unclamping
4 characteristics of the gott shunt
proximal to distal aorta shunting
additional fem. a-line to assess perfusion
partial anti-coagulation required
2 characteristics of partial left-sided heart bypass
occurs if aneurysm is proximal enough to the aortic arch or aorta too calcified
What do you want to avoid during induction of the TAAA patient
minimize an increase or a precipitous drop in blood pressure
What would be the DOC for hypertensive episode during induction of the TAAA pt.
esmolol or other beta blockers
What are 4 risk factors for spinal ischemia in the TAAA patient
duration of cross clamp
presence of dissection
With descending TAAA and dissections, what can be done to alleviate increase in CSF
CSF drain (lumbar drain in place)
placed if pressure exceeds 10mmHg
left in for 24hours
What are 6 complications of spinal drain complications placed for the TAAA patient
spinal cord injury
What are 4 drugs that have been used to help protect the spinal cord
Treatment regimen for delayed onset spinal cord ischemia
elevation of blood pressure (increase MAP)
consider CSF drainage
frequent neuro checks
What is the most common site of injury to the aorta during mechanical injury
site of fixation of the aorta to the thorax known as the ligamentum arteriosum
Ascending aorta and arch aneurysms and dissections have similar considerations to what type of surgery and what might it involve
similar to open heart surgery
might involve aortic valve replacement and will often have aortic regurge
3 requirements for ascending aorta and arch aneurysms and dissections
will require CPB, full anticoagulation, and no cross-clamping
Of Type A and type B, which is most likely to be treated medically and which surgically?
type A - surgically
type B - medically
What are 3 other risk factors for dissection
ehlers danlos syndrome
Early treatment of ascending aorta and arch aneurysms and dissections
decrease blood pressure (maintain end-organ perfusion)
nicardepine, beta blockers, NTG, nipride
What is a patient at risk for with aortic arch surgery
high risk of stroke and ischemic brain injury due to interruption of cerebral perfusion
How long can ischemic tolerance last at 15 and 10 deg. C
10 deg. C = 40 minutes
15 deg. C = 30 minutes
What are 3 drugs that are often used in conjunction with DHCA?
What dosage of sodium thiopental and propofol have been used with DHCA
sodium thiopental - 2-40mg/kg
propofol - 3-10mg/kg
What vessels is used during retrograde cerebral perfusion is what is the idea behind this method?
the SVC is used. Cold oxygenated blood is delivered with idea to provide some oxygen and nutrients to the brain
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